Complete clinical responses to cancer therapy caused by multiple divergent approaches: a repeating theme lost in translation

Over 50 years of cancer therapy history reveals complete clinical responses (CRs) from remarkably divergent forms of therapies (eg, chemotherapy, radiotherapy, surgery, vaccines, autologous cell transfers, cytokines, monoclonal antibodies) for advanced solid malignancies occur with an approximately similar frequency of 5%–10%. This has remained frustratingly almost static. However, CRs usually underpin strong durable 5-year patient survival. How can this apparent paradox be explained? Over some 20 years, realization that (1) chronic inflammation is intricately associated with cancer, and (2) the immune system is delicately balanced between responsiveness and tolerance of cancer, provides a greatly significant insight into ways cancer might be more effectively treated. In this review, divergent aspects from the largely segmented literature and recent conferences are drawn together to provide observations revealing some emerging reasoning, in terms of “final common pathways” of cancer cell damage, immune stimulation, and auto-vaccination events, ultimately leading to cancer cell destruction. Created from this is a unifying overarching concept to explain why multiple approaches to cancer therapy can provide complete responses at almost equivalent rates. This “missing” aspect provides a reasoned explanation for what has, and is being, increasingly reported in the mainstream literature – that inflammatory and immune responses appear intricately associated with, if not causative of, complete responses induced by divergent forms of cancer therapy. Curiously, whether by chemotherapy, radiation, surgery, or other means, therapy-induced cell injury results, leaving inflammation and immune system stimulation as a final common denominator across all of these mechanisms of cancer therapy. This aspect has been somewhat obscured and has been “lost in translation” to date

Integrative review : Factors impacting effective delegation practices by registered nurses to assistants in nursing

Aim To identify the evidence on factors that impact delegation practices by Registered Nurses to Assistants in Nursing in acute care hospitals. Design An integrative review. Data Sources Database searches were conducted between July 2011 and July 2021. Review Methods We used the 12-step approach by Kable and colleagues to document the search strategy. The (Whittemore & Knafl. 2005. Journal of Advanced Nursing, 52(5), 546–553) integrative review framework method was adopted and the methodological quality of the studies was assessed using Joanna Briggs critical appraisal instruments. Results Nine studies were included. Delegation between the Registered Nurse and the Assistant in Nursing is a complex but critical leadership skill which is impacted by the Registered Nurse's understanding of the Assistant in Nursing's role, scope of practice and job description. Newly qualified nurses lacked the necessary leadership skills to delegate. Further education on delegation is required in pre-registration studies and during nurses' careers to ensure Registered Nurses are equipped with the skills and knowledge to delegate effectively. Conclusion With increasing numbers of Assistants in Nursing working in the acute care environment, it is essential that Registered Nurses are equipped with the appropriate leadership skills to ensure safe delegation practice

Is treatment of depression cost-effective in people with diabetes? A systematic review of the economic evidence

PublishedJournal ArticleResearch Support, Non-U.S. Gov'tReviewOBJECTIVES: Depression is common in diabetes and linked to a wide range of adverse outcomes. UK policy indicates that depression should be treated using conventional psychological treatments in a stepped care framework. This review aimed to identify current economic evidence of psychological treatments for depression among people with diabetes. METHOD: Electronic search strategies (conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, NHS EED) combined clinical and economic search terms to identify full economic evaluations of the relevant interventions. Prespecified screening and inclusion criteria were used. Standardized data extraction and critical appraisal were conducted and the results summarized qualitatively. RESULTS: Excluding duplicates, 1,516 studies for co-morbid depression and diabetes were screened. Four economic evaluations were identified. The studies found that the interventions improved health status, reduced depression and were cost-effective compared with usual care. The studies were all U.S.-based and evaluated collaborative care programs that included psychological therapies. Critical appraisal indicated limitations with the study designs, analysis and results for all studies. CONCLUSIONS: The review highlighted the paucity of evidence in this area. The four studies indicated the potential of interventions to reduce depression and be cost-effective compared with usual care. Two studies reported costs per QALY gained of USD 267 to USD 4,317, whilst two studies reported the intervention dominated usual care, with net savings of USD 440 to USD 612 and net gains in patient free days or QALYs

Integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing

Aim To identify the evidence on factors that impact delegation practices by Registered Nurses to Assistants in Nursing in acute care hospitals. Design An integrative review. Data Sources Database searches were conducted between July 2011 and July 2021. Review Methods We used the 12-step approach by Kable and colleagues to document the search strategy. The (Whittemore & Knafl. 2005. Journal of Advanced Nursing, 52(5), 546–553) integrative review framework method was adopted and the methodological quality of the studies was assessed using Joanna Briggs critical appraisal instruments. Results Nine studies were included. Delegation between the Registered Nurse and the Assistant in Nursing is a complex but critical leadership skill which is impacted by the Registered Nurse\u27s understanding of the Assistant in Nursing\u27s role, scope of practice and job description. Newly qualified nurses lacked the necessary leadership skills to delegate. Further education on delegation is required in pre-registration studies and during nurses\u27 careers to ensure Registered Nurses are equipped with the skills and knowledge to delegate effectively. Conclusion With increasing numbers of Assistants in Nursing working in the acute care environment, it is essential that Registered Nurses are equipped with the appropriate leadership skills to ensure safe delegation practice

Risk perceptions of cyber-security and precautionary behaviour

A quantitative empirical online study examined a set of 16 security hazards on the Internet and two comparisons in 436 UK- and US students, measuring perceptions of risk and other risk dimensions. First, perceived risk was highest for identity theft, keylogger, cyber-bullying and social engineering. Second, consistent with existing theory, significant predictors of perceived risk were voluntariness, immediacy, catastrophic potential, dread, severity of consequences and control, as well as Internet experience and frequency of Internet use. Moreover, control was a significant predictor of precautionary behaviour. Methodological implications emphasise the need for non-aggregated analysis and practical implications emphasise risk communication to Internet users

Blood sampling through peripheral intravenous cannulas: A look at current practice in Australia

Background: Sampling blood from a peripheral intravenous cannula offers an alternative to venepuncture. This practice can reduce frequency of venepuncture and patient discomfort. Opponents argue the practice increases the chance of haemolysis, risk of infection and device failure. Aim: To describe the prevalence and practice of blood sampling from peripheral intravenous cannulas by Australian nurses. Methods: This study used a descriptive cross-sectional design and data were collected using an electronic survey. The survey examined Australian nurses’ practice of sampling blood from peripheral intravenous cannulas. Quantitative descriptive data was analysed and presented as frequencies, percentages, medians and ranges. Findings: A total of 542 nurses participated in the survey. Of these, 338 (62.4%) completed the survey. The majority of responses came from the State of Victoria (n = 137, 40.5%) and one-third were emergency nurses (n = 112, 33.1%). Sampling of blood from peripheral intravenous cannulas occurred between 37.5% and 66.7% throughout the State and Territories of Australia. Peripheral intravenous cannula blood sampling was most common in the emergency department (n = 93, 53.4%). The most frequent reasons given were difficulty of access (n = 223, 66.0%) followed by patient comfort (n = 194, 57.4%). Discussion: Blood sampling is required to diagnose and monitor treatment responses. A peripheral intravenous cannula offers the opportunity to sample blood without the need for venepuncture. Practice recommendations on when to sample blood and correct sampling technique are based on limited or conflicting evidence. Conclusion: Findings from this study indicate it is common practice to draw blood samples from a peripheral intravenous cannula. Further research is required to examine the accuracy and safety of this practice to further inform policy

Quality of seed produced by tropical forage legumes on low fertility soils

This study compared seed yields, seed and seedling characteristics of 8 forage legumes including Stylosanthes spp, Centrosema spp, Desmanthus spp, and Macroptilium spp grown on red and yellow kandosol soils of low fertility

The burden of self-reported antibiotic allergies in health care and how to address it: A systematic review of the evidence

Background: Antibiotics are the first-line treatment for bacterial infections; however, overuse and inappropriate prescribing have made antibiotics less effective with increased antimicrobial resistance. Unconfirmed reported antibiotic allergy labels create a significant barrier to optimal antimicrobial stewardship in health care, with clinical and economic implications. Objective: A systematic review was conducted to summarize the impact of patient-reported antibiotic allergy on clinical outcomes and various strategies that have been employed to effectively assess and remove these allergy labels, improving patient care. Methods: The review was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A critical appraisal was conducted on all studies and a narrative synthesis was performed to identify themes. Results: Four themes emerged: the prevalence of antibiotic allergy, impact of antibiotic allergy on antimicrobial prescribing, impact of antibiotic allergy on clinical outcomes, and delabeling strategies to improve clinical outcomes. Of the 32 studies, including 1,089,675 participants, the prevalence of reported antibiotic allergy was between 5% and 35%. Patients with a reported antibiotic allergy had poorer concordance with prescribing guidelines in 30% to 60% of cases, with a higher use of alternatives such as quinolone, tetracycline, macrolide, lincosamide, and carbapenem and lower use of beta-lactam antibiotics. Antibiotic allergy delabeling was identified as an intervention and recommendation to advance the state of the science. Conclusions: There is substantial evidence within the literature that antibiotic allergy labels significantly impact patient clinical outcomes and a consensus that systematic assessment of reported antibiotic allergies, commonly referred to as delabeling, improves the clinical management of patients

Altered hippocampal function in major depression despite intact structure and resting perfusion

Background: Hippocampal volume reductions in major depression have been frequently reported. However, evidence for functional abnormalities in the same region in depression has been less clear. We investigated hippocampal function in depression using functional magnetic resonance imaging (fMRI) and neuropsychological tasks tapping spatial memory function, with complementing measures of hippocampal volume and resting blood flow to aid interpretation. Method: A total of 20 patients with major depressive disorder (MDD) and a matched group of 20 healthy individuals participated. Participants underwent multimodal magnetic resonance imaging (MRI): fMRI during a spatial memory task, and structural MRI and resting blood flow measurements of the hippocampal region using arterial spin labelling. An offline battery of neuropsychological tests, including several measures of spatial memory, was also completed. Results: The fMRI analysis showed significant group differences in bilateral anterior regions of the hippocampus. While control participants showed task-dependent differences in blood oxygen level-dependent (BOLD) signal, depressed patients did not. No group differences were detected with regard to hippocampal volume or resting blood flow. Patients showed reduced performance in several offline neuropsychological measures. All group differences were independent of differences in hippocampal volume and hippocampal blood flow. Conclusions: Functional abnormalities of the hippocampus can be observed in patients with MDD even when the volume and resting perfusion in the same region appear normal. This suggests that changes in hippocampal function can be observed independently of structural abnormalities of the hippocampus in depression

Myocardial infarction: Sex differences in symptoms reported to emergency dispatch

Background: Emergency management of myocardial infarction(MI) is time-critical, because improved patient outcomes are associated with reduced time from symptom onset to definitive care. Previous studies have identified that women are less likely to present with chest pain.Objective: We sought to measure the effect of sex on symptoms reported to the ambulance dispatch and ambulance times for MIpatients.Methods: The Western Australia Emergency Department Information System (EDIS) was used to identify patients with emergency department (ED) diagnoses of MI(ST-segment elevation MI and non–ST-segment elevation MI) who arrived by ambulance between January 1, 2008,and October 31, 2009. Their emergency telephone calls to the ambulance service were transcribed to identify presenting symptoms. Ambulance data were used to examine ambulance times. Sex differences were analyzed using descriptive and age-adjusted regression analysis.Results: Of 3,329MI patients who presented to Perth EDs, 2,100 (63.1%) arrived by ambulance. After predefined exclusions, 1,681 emergency calls were analyzed. The women (n = 621; 36.9%) were older than the men (p < 0.001) and, even after age adjustment, were less likely to report chest pain (odds ratio[OR] = 0.70; 95% confidence interval [CI] 0.57, 0.88). After age adjustment, ambulance times did not differ between the male and female patients with chest pain. The women with chest pain were less likely than the men with chest pain to be allocated a “priority 1” (lights and sirens) ambulance response (men 98.3% vs. women 95.5%; OR = 0.39; 95% CI0.18, 0.87).Conclusion. Ambulance dispatch officers (and paramedics) need to be aware of potential sex differences in MI presentation in order to ensure appropriate ambulance response